摘要
目的 :研究高通量透析对维持性血液透析患者甲状旁腺素 (PTH)水平及相关骨代谢的影响 ,并分析可能的作用机制。 方法 :91例维持性血液透析患者 ,根据其使用透析器不同 ,分为高通量组 (HF组 ,n =5 4例 )、低通量组 (LF组 ,n =37例 ) ,比较两组在维持透析时间 <5年、5～ 10年及 >10年三个时间段患者血PTH及透析前、后血钙 ,透析前血磷 ,透析后血磷下降率 ;同时两组各选择 15例患者比较骨活检病理改变 ;分析造成高、低通量透析患者血PTH水平及骨病理差异的可能原因。 结果 :随透析年限的延长 ,低通量透析患者血PTH大幅度升高 ,而高通量透析患者则为轻度升高。透析年限 <5 ,5～ 10年及 >10年三个时间段 ,高通量透析患者血PTH水平都非常显著低于低通量透析组患者 ,分别为 (10 5 6± 130 2 )pg/Lvs (5 0 7 8± 42 6 8)pg/L(P <0 0 1) ,(2 2 5 4± 333 0 )pg/Lvs (10 35 1± 92 8 5 )pg/L(P <0 0 1) ,(2 38 2± 333 0 )pg/Lvs (1797 7± 85 3 9)pg/L(P <0 0 1)。骨活检病理病变 (类骨质面积 ,破骨细胞数 )也显著轻于低通量透析患者 (P <0 0 5 )。高、低通量透析患者透析前血钙 (2 49± 0 2 2mmol/Lvs 2 14± 0 2 6mmol/L )、透析后血钙 (2 84± 0 18mmol/Lvs 2 5 5± 0 35mmol/L ) ,及透?
Objective:To investigate the difference of clinical and pathological parameters for renal osteodystrophy between high flux and low flux maintenance hemodialysis patients. Methodology:Ninety one maintenance hemodialysis(MHD)patients were involved in this study,among them 54 treated with high flux dialyzers(HF group,dialyzers F60 or BLS627)and 37 with low flux dialyzers(LF group,dialyzers ME15H and ME12H).Serum PTH,pre dialysis and post dialysis levels of serum calcium(Ca),phosphorus(P)or reduction of P after dialysis were determined and compared between patients in HF and LF groups according to theyears on MHD(<5,5 10,and>10 years).Bone biopsy were performed in 15 patients of each group and histological changes were evaluated. Results:The average serum PTH level was significantly lower in HF group than in LF group(151.4±200.7 vs 1119.3±924.6, P <0.001),as well as in patients of different dialysis years of the two groups(<5 years:105.6±130 2 vs 507 8±426 8 pg/L, P <0.001;5 10 years:225.4±333.0 vs 1035 1±928 5 pg/L, P <0.005;>10 years:238 2±333 0 vs 1797 7±853 9 pg/L, P <0 001).Histological parameters of osteodystrophy (osteoid area,osteoblast number)were found less severe in HF group as compared to those in LF group ( P <0 05).Very significant difference was found between HF and LF groups in pre dialysis serum Ca levels(2 49±0 22 vs 2 14±0 26 mmol/L, P <0 001),post dialysis serum Ca levels(2 84±0 18 vs 2 55±0 35 mmol/L, P <0 001) and P reduction(57 4±9 87 vs 45 7±13 3%, P <0 001).Conclusion:As compared to low flux dialysis,high flux dialysis can improve not only serum PTH level,but also clinical and pathological parameters related with renal osteodystrophy in MHD patients.These effects can be attributed to the removal of serum phosphorus.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2001年第4期317-321,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
